Retrospective Study of Utilization of Acute Ischemic Stroke Reperfusion Therapies in Pregnant and Postpartum Women Using MarketScan Data
Restricted (Penn State Only)
- Author:
- Shankar, Lakshmi
- Graduate Program:
- Public Health Sciences
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- October 28, 2024
- Committee Members:
- Li Wang, Professor in Charge/Director of Graduate Studies
Kristin Elizabeth King Sznajder, Thesis Advisor/Co-Advisor
Guodong Liu, Committee Member - Keywords:
- Stroke
Maternal Stroke
IV thrombolysis
Stroke Treatments - Abstract:
- Maternal strokes are an infrequent but significant complication in pregnancy. There have been several advances in the treatment of acute ischemic stroke in the last 3 decades. There is a reluctance in adoption of these treatments for maternal strokes due to lack of systematic studies evaluating the maternal and fetal risks of these treatments. Following more recent changes in guidelines and contraindications, we aim to study any change in utilization of acute stroke therapies in maternal stroke. The MarketScan® database was used to identify 9568 women aged 18-45 with acute ischemic stroke at hospitalization, from 2017-2022. T-test and Chi-square tests were used to perform subgroup analysis among pregnant, postpartum, non-pregnant non-postpartum patients to ascertain differences in baseline characteristics, utilization of acute stroke therapies and discharge dispositions. Logistic regression analysis was used to determine the effect of select variables on the lack of treatment. Pregnant patients were younger (mean age of 31.10) and had fewer comorbidities (CCI index 1.51). Hypertension was noted in 40.38% in our study population, with 22.19% in the pregnant group and 41.18% in the postpartum group. Hypertensive Disorders of Pregnancy was seen in 33.5% in the pregnant and postpartum cohort. Coagulopathy was noted in 34.3% in the postpartum group and 12.22% in the pregnant group. Utilization of any stroke treatment was the lowest in the pregnant group compared to postpartum and non-pregnant non-postpartum groups (7.98% vs 9.84% vs 14.66%, p = 0.0006). Utilization of IV tPA was similar in pregnant and postpartum groups but higher in non-pregnant non-postpartum group (4.74% vs 3.28% vs 12.37%, p <0.0001). Postpartum patients and those who received EVT had higher discharges to rehabilitative services. Pregnancy is associated with lower odds of receiving IV thrombolysis (OR 0.3, 95% CI 0.19 -0.51, p<0.0001), higher CCI was associated with higher odds of receiving IV thrombolysis (OR 1.06, 95% CI 1.03 – 1.09, p<0.0001). There has been no significant change in use of acute stroke therapies in maternal stroke compared to prior studies. Further studies evaluating fetal and maternal outcomes will likely improve adoption of these treatments. Hypertension and hypertensive disorders of pregnancy are potential targets of intervention to improve maternal outcomes.